Cardiac Tropism of Borrelia burgdorferi

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Cardiac Tropism of Borrelia burgdorferi Atis Muehlenbachs, Brigid C. Bollweg, Thadeus J. Schulz, Joseph D. Forrester, Marlene DeLeon Carnes, Claudia Molins, Gregory S. Ray, Peter M. Cummings, Jana M. Ritter, Dianna M. Blau, Thomas A. Andrew, Margaret Prial, Dianna L. Ng, Joseph A. Prahlow, Jeanine H. Sanders, Wun Ju Shieh, Christopher D. Paddock, Martin E. Schriefer, Paul Mead, Sherif R. Zaki The American Journal of Pathology Volume 186, Issue 5, Pages 1195-1205 (May 2016) DOI: 10.1016/j.ajpath.2015.12.027 Copyright © 2016 Terms and Conditions

Figure 1 Pathology of Lyme myocarditis. A–C: Carditis with interstitial perivascular lymphoplasmacytic infiltrates in a road map distribution. D: Atrioventricular node. The atrioventricular artery is seen in the upper right. Infiltrates involve epicardial adipose tissue (E) and endocardium (F). Original magnification: ×6.25 (A and D); ×12.5 (B); ×25 (E); ×50 (C and F). The American Journal of Pathology 2016 186, 1195-1205DOI: (10.1016/j.ajpath.2015.12.027) Copyright © 2016 Terms and Conditions

Figure 2 Spirochetes within cardiac tissue. Spirochetes are seen by Warthin-Starry stain (A) and Borrelia species immunohistochemistry (B). Original magnification, ×158 (A and B). The American Journal of Pathology 2016 186, 1195-1205DOI: (10.1016/j.ajpath.2015.12.027) Copyright © 2016 Terms and Conditions

Figure 3 Neuropathology. Brain with mild leptomeningeal lymphocytic infiltrates (A) and rare spirochetes (arrowhead) by Borrelia species immunohistochemistry (B). Original magnification: ×25 (A); ×100 (B). The American Journal of Pathology 2016 186, 1195-1205DOI: (10.1016/j.ajpath.2015.12.027) Copyright © 2016 Terms and Conditions

Figure 4 Localization of spirochetes with collagen and decorin. A: Lyme carditis cases show increased interstitial collagen by trichrome stain (blue). B: Cardiac decorin protein is localized to the interstitium by immunohistochemistry (red). C: Spirochetes by immunohistochemistry (IHC) (red, arrowhead) are seen along clear refractile collagen fibers. Collagen fibers are highlighted by decreasing the optical condenser aperture diaphragm (not shown). On consecutive sections, collagen fibers stain blue (arrowhead) by trichrome (D) and label with decorin (red, arrowhead) by IHC (E). Original magnification: ×50 (A and B); ×100 (C, D, and E). The American Journal of Pathology 2016 186, 1195-1205DOI: (10.1016/j.ajpath.2015.12.027) Copyright © 2016 Terms and Conditions